Endoscopic surgical stapling instrument with pivotable and rotatable staple cartridge

ABSTRACT

A surgical stapler is provided which is insertable through an endoscopic tube to enable a surgeon to staple a hernia patch to tissue inside a body cavity. The endoscopic surgical stapler includes a staple cartridge pivotally mounted on the distal end of a support tube extending from a handle provided with an actuator mechanism for actuating a staple forming mechanism inside the staple cartridge to fasten staples to the tissue. The staple cartridge is adjustable to different angular orientations relative to the support tube. The staple actuator mechanism is operable to actuate the staple cartridge in any of the angular orientations. The support shaft is rotatable about its longitudinal axis relative to the handle to adjust the rotational orientation of the support shaft and the staple cartridge. The staple cartridge is rotatable about its longitudinal axis relative to the support shaft to adjust the rotational position of the staple cartridge relative to the support shaft. Separate actuator mechanisms are provided on the handle to control the pivotal movement of the staple cartridge, the rotation of the support shaft, and the rotation of the staple cartridge relative to the support shaft.

This is a division of application Ser. No. 08/338,316, filed Nov. 14,1994, which is a continuation of application Ser. No. 07/959,184, filedOct. 9, 1992 now U.S. Pat. No. 5,381,943 both of which are herebyincorporated by reference.

FIELD OF THE INVENTION

The present invention relates to a surgical stapling instrument forapplying surgical staples to internal body tissue and, moreparticularly, to a surgical stapler which can be used endoscopically forthe repair of hernias. More specifically, this invention relates to anendoscopic surgical stapling instrument including a staple cartridgewhich is pivotally and rotatably mounted to allow the surgical staplesto be applied to the internal body tissue in any desired orientation.Also, this invention concerns a unique staple cartridge with an improvedstaple forming mechanism for advancing and fastening the staples to thetissue.

BACKGROUND OF THE INVENTION AND PRIOR ART

With the proliferation of endoscopic surgery, it has been realized thatthere are many procedures typically performed in open surgery which canbe performed endoscopically. A trocar, which is a pointed piercingdevice, is inserted into the body with a cannula placed around thetrocar. After the trocar pierces the abdominal walls, it is removed andthe cannula remains in the body. Through this cannula, endoscopicprocedures can be conducted. Generally, the endoscopic procedures areperformed under insufflation. Some of the more typical procedures havebeen gall bladder removal, tissue repair and sterilization proceduressuch as occluding of the fallopian tubes.

Surgeons realize that it may be possible to perform additionalprocedures endoscopically, once the proper materials and mechanismsbecome available for performing these procedures. One of the more basic,and quite logical extensions of current endoscopic procedures has beenfocused on the repair of hernias. It is realized that to have thecapability of performing hernia repair endoscopically will benefit themedical community in many ways. Specifically, it is realized thatendoscopic hernia repair will allow the patient to recuperate morerapidly, and without the more than likely extensive physical therapycurrently practiced as a result of a hernia repair performed by opensurgery.

Moreover, it is realized that hernia repair procedures may containaspects which are applicable in other procedures. For instance, if it ispossible to cover, or reinforce and constrain a hernia, it may bepossible to apply this procedure to other vessels or organs, in asimilar manner. Also, it is realized that once a device becomesavailable wherein hernias can be repaired, many of the functionalcomponents of the hernia repair device will be useful in other devicescapable of performing other procedures. Also, naturally, thesemechanisms may be useful for procedures in which open surgery isperformed.

SUMMARY OF THE INVENTION

Accordingly, it is an object of the present invention to provide anendoscopic surgical stapler for applying staples to secure a herniarepair patch to internal body tissue.

Another object of the invention is to provide an endoscopic surgicalstapler including a staple cartridge which is pivotally and rotatablymounted to allow the staples to be fastened to the tissue in any desiredorientation.

It is also an object of the invention to provide an endoscopic surgicalstapling instrument in which the pivotal movement and rotation of thestaple cartridge can be controlled from a remote actuator handleassembly.

It is another object of the invention to provide an endoscopic surgicalstapling instrument which facilitates manipulation by a surgeon tocontrol the orientation and acutation of the staple cartridge.

A further object of the invention is to provide a staple cartridge foruse with a surgical stapling instrument which includes an improvedstaple forming mechanism for advancing the staples one at a time intoengagement with an anvil about which the staple is formed to secure thestaple to the tissue.

The present invention achieves an improved endoscopic surgical staplerwhich is adapted for insertion through an endoscopic tube or cannulainto a body cavity to apply one or more surgical staples to the internalbody tissue. The surgical stapling instrument includes a staplecartridge which is pivotally mounted at the distal end of a tubularsupport shaft extending from a handle which includes a staple actuatormechanism for actuating the staple cartridge to fasten the staplesseriatim to the tissue. The staple cartridge is mounted for pivotalmovement relative to the support shaft about an axis transverse to thelongitudinal axis of the support shaft to permit the angular orientationof the staple cartridge to be adjusted. Also, the staple cartridge ismounted for rotation relative to the support shaft to permit therotational orientation of the staple cartridge to be adjusted. Inaddition, the support shaft is rotatable about its longitudinal axisrelative to the handle. These features of the stapling instrument allowthe staple cartridge to be precisely aligned with the desired region ofthe internal body tissue to which the staple is applied. Separateactuator mechanisms are provided on the handle for controlling therotation of the support shaft, the pivoting of the staple cartridgerelative to the support shaft, and the rotation of the staple cartridgerelative to the support shaft. These actuator mechanisms facilitatemanipulation of the stapling instrument by a surgeon to position thestaple cartridge in a desired orientation.

In accordance with one aspect of the invention, the surgical staplinginstrument is provided with pivot means at the distal end of the supportshaft for mounting the staple cartridge for pivotal movement about anaxis transverse to the longitudinal axis of the support shaft. Actuatormeans is provided on the handle for pivoting the staple cartridge aboutthe transverse axis to adjust the angular position of the staplecartridge relative to the support shaft. The stapling instrumentincludes means for retaining the staple cartridge in different angularpositions relative to the support shaft. The staple cartridge has astaple forming mechanism which can be actuated by the staple actuatormechanism with the staple cartridge oriented in any of its differentangular positions.

The surgical stapling instrument includes actuator means on the handlefor rotating the support shaft about its longitudinal axis to adjust therotational orientation of the support shaft and the staple cartridge.Also, means is provided for retaining the support shaft in differentrotational positions as the support shaft is rotated about itslongitudinal axis.

In a preferred embodiment of the surgical stapling instrument, thestaple cartridge is mounted for rotation about its longitudinal axisrelative to the support shaft. Actuator means is provided on the handlefor rotating the staple cartridge to adjust the rotational position ofthe staple cartridge relative to the support shaft. Also, means isprovided for retaining the staple cartridge in different rotationalpositions as the staple cartridge is rotated about its longitudinal axisrelative to the support shaft.

In accordance with another aspect of the invention, a staple cartridgefor use with a stapling instrument for applying one or more surgicalstaples to tissue comprises a cartridge housing adapted to receive aplurality of staples in a row for longitudinal movement therethrough, ananvil mounted on the housing, means for advancing the forwardmost staplein the row into engagement with the anvil, means for rotating theforwardmost staple from a transverse orientation into a longitudinalorientation as the staple is advanced toward the anvil, and means forforming the forwardmost staple about the anvil to attach the staple tothe tissue. The staple advancing means comprises a staple holderslidably mounted within the cartridge housing for advancing theforwardmost staple from the row and clamping the staple against theanvil. The staple rotating means comprises ramp means on the cartridgehousing for engaging and rotating the forwardmost staple into alongitudinal orientation as the staple is advanced by the staple holder.The staple forming means comprises a staple former slidably mountedwithin the cartridge housing for movement relative to the staple holderand adapted to form the forwardmost staple about the anvil. Preferably,the staple holder includes an ejector arm for removing the forwardmoststaple from the anvil after the staple is formed.

A preferred embodiment of the staple cartridge is adapted for use with astaple having a generally U-shaped body including a crown with a centraloffset portion and a pair of depending legs at opposite sides of thecrown. The staple cartridge comprises an elongated hollow cylindricalcartridge housing including a pair of spaced parallel guide railstherein for slidably supporting a stack of staples for longitudinalmovement therealong with the staple crowns resting on the guide railsand the staple legs oriented perpendicularly to the longitudinal axis ofthe cartridge housing. A staple follower is slidably mounted on theguide rails for urging the staples forwardly on the guide rails towardthe distal end of the cartridge housing. An anvil is mounted adjacent tothe distal end of the cartridge housing. A staple holder is slidablymounted between the guide rails for engaging the central offset portionof the forwardmost staple to advance the staple from the stack intoengagement with the anvil. Ramp means is provided on the cartridgehousing for engaging the crown of the forwardmost staple advanced by thestaple holder and rotating the staple into a longitudinal orientationwith the staple legs oriented parallel to the longitudinal axis of thecartridge housing. A staple former is slidably mounted between the guiderails and movable relative to the staple holder for engaging the crownof the forwardmost staple to form the staple about the anvil to attachthe staple to the tissue.

In the preferred embodiment of the staple cartridge, the staple formercomprises an elongated channel-shaped member including upstanding sideflanges extending along its opposite sides for engaging and forming thestaple. The staple holder comprises an elongated plate-like memberslidably supported on the staple former and located between the sideflanges. The staple holder includes a notch at its distal end forreceiving the forwardmost staple to be advanced. The staple holder alsoincludes a pusher finger at its distal end for engaging the forwardmoststaple and clamping the staple against the anvil. In addition, thestaple holder includes an ejector arm at its distal end for removing theformed staple from the anvil when the staple holder is retracted.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, aspects and advantages will be betterunderstood from the following detailed description of the preferredembodiments of the invention with reference to the drawings, in which:

FIG. 1 is an overall perspective view of an endoscopic surgical staplinginstrument constructed in accordance with this invention;

FIG. 2 is a partially cutaway side view of the stapling instrument ofFIG. 1;

FIG. 3 is an enlarged longitudinal section of the stapling head assemblyof FIG. 2;

FIG. 4 is an enlarged longitudinal section of the stapling head assemblyfrom the opposite side of FIG. 3;

FIGS. 5 and 6 are exploded perspective views showing the components ofthe stapling instrument of FIG. 1;

FIG. 7 is an enlarged partially cutaway horizontal section of thestapling head assembly and support shaft of FIG. 2;

FIG. 8 is an enlarged partially cutaway vertical section of the staplinghead assembly and support shaft of FIG. 2;

FIG. 9 is an enlarged, exploded perspective view showing the staplecartridge and the staple forming mechanism of the stapling headassembly;

FIG. 10 is an enlarged longitudinal section of the staple cartridge ofFIG. 9;

FIG. 11 is an enlarged longitudinal section of the staple cartridgealong line 11--11 of FIG. 10;

FIG. 12 is an enlarged proximal end view of the staple cartridge;

FIG. 13 is an enlarged distal end view of the stapling head assembly ofFIG. 3;

FIG. 14 is an enlarged fragmentary section of the staple cartridge takenalong line 14--14 of FIG. 11;

FIG. 15 is a longitudinal section of a slide actuator for pivoting thestapling head assembly;

FIG. 16 is a proximal end view of the slide actuator of FIG. 15;

FIG. 17 is an enlarged plan view of a staple for use with the surgicalstapling instrument of this invention;

FIG. 18 illustrates a hernia repair patch fastened to tissue withstaples applied by the surgical stapling instrument of this invention;

FIG. 19 is an enlarged longitudinal section of the staple cartridge ofFIG. 9 showing the staple forming mechanism in a retracted position;

FIG. 20 is an enlarged longitudinal section of the staple cartridge ofFIG. 9 showing the staple forming mechanism advanced to rotate a stapleinto a longitudinal orientation;

FIG. 21 is an enlarged longitudinal section of the staple cartridge ofFIG. 9 showing the staple forming mechanism advanced to clamp the stapleagainst an anvil of the staple cartridge;

FIGS. 22-26 illustrate the operation of the staple forming mechanism inadvancing and forming a staple;

FIGS. 27-31 are fragmentary views showing the operation of a precockratchet mechanism in the actuator handle assembly;

FIG. 32 is an overall perspective view of an alternative embodiment ofthe surgical stapling instrument constructed in accordance with thisinvention;

FIG. 33 is a partially cutaway side view of the stapling instrument ofFIG. 32;

FIG. 34 is an enlarged longitudinal section of the stapling headassembly from the opposite side of FIG. 32;

FIG. 35 is an enlarged cross section of the stapling instrument alongline 35--35 of FIG. 33;

FIG. 36 is an enlarged cross section of the stapling instrument alongline 36--36 of FIG. 33;

FIG. 37 is a perspective view of another embodiment of a stapling headassembly for use with the surgical stapling instrument of thisinvention;

FIG. 38 is a side view of the stapling head assembly from the oppositeside of FIG. 37;

FIG. 39 is a partially cutaway side view of the stapling head assemblyof FIG. 38; and

FIG. 40 is a partially cutaway side view of the stapling head assemblyfrom the opposite side of FIG. 39.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring to FIG. 1, the present invention is embodied in anarticulating endoscopic surgical stapling instrument, generally 50,including a distal stapling head assembly 60 which is pivotallyconnected to an elongated support tube 70 rotatably mounted on aproximal actuator handle assembly 80. A rotatable adjusting knob 82 ismounted at the distal end of the actuator handle assembly 80 forrotating the support tube 70 about its longitudinal axis. Asaddle-shaped actuator 84 is slidably mounted on the actuator handleassembly 80 for controlling the pivotal movement of the stapling headassembly 60 relative to the support tube 70. The actuator handleassembly 80 includes a depending handle grip 86 and a pivotally mountedstaple actuating lever 88 for actuating a staple cartridge 100 on thestapling head assembly 60. Preferably, the actuator handle assembly 80,the adjusting knob 82, the saddle-shaped actuator 84 and the stapleactuating lever 88 consist of plastic material.

Referring to FIG. 14, a staple 65 adapted for use with the surgicalstapling instrument 50 of the present invention comprises a wire-likebody of circular cross section which is bent in a generally U-shapedconfiguration. Preferably, the staple 65 consists of titanium orstainless steel. The staple 65 includes a top portion or crown 66provided with a central dimpled portion 67 which is offset downwardlyfrom the crown 66 by an amount approximately equal to the diameter ofthe circular cross section of the staple 65. The opposite sides of thestaple 65 are bent downwardly to provide a pair of depending legs 68which are substantially perpendicular to the crown 66. Each leg 68 has abeveled end 69 which is beveled at an angle of approximately 45 degrees.When the staple 65 is closed by operation of the surgical staplinginstrument 50, the staple legs 68 overlap each other as shown by phantomlines in FIG. 17 to secure the staple to the tissue.

As shown in FIGS. 1 and 5, the handle assembly 80 includes a pair ofhollow handle sections 91 and 92 which are adapted to snap fit together.The handle sections 91 and 92 include distally extending elongated,semi-cylindrical neck portions 93 and 94 which receive the proximal endof the support tube 70 therebetween and mount the support tube 70 forrotation about its longitudinal axis relative to the handle assembly 80.Each of the handle sections 91 and 92 includes an internal annularflange 95 (one shown) for engaging a radially projecting flange 72 atthe proximal end of the support tube 70 to retain the support tube 70within the handle assembly 80. The staple actuating lever 88 ispivotally mounted on the actuator handle assembly 80 by a pivot pin 96extending through a pivot hole 90 in the lever 88. The pivot pin 96 isreceived in a pair of hollow cylindrical support stems 97 (one shown)formed on the inside of the handle sections 91 and 92.

As shown in FIGS. 1 and 5, the adjusting knob 82 comprises a pair ofelongated hollow, tapered sleeve-like sections 101 and 102 which fittogether over the neck portions 93 and 94 of the handle sections 91 and92, respectively. Each of the sleeve-like knob sections 101 and 102 hasan inwardly projecting prong 103 adjacent to its distal end. The prongs103 are received in a pair of holes 74 (one shown) formed on oppositesides of the support tube 70 to secure the knob sections 101 and 102 tothe support tube 70. Each of the knob sections 101 and 102 includes asemi-circular ratchet 104 on its inner wall for engaging a pair ofdetents 105 mounted on resilient arms 106 formed on each of the handlesections 91 and 92. The semi-circular ratchets 104 and the detents 105provide a ratchet mechanism for retaining the support tube 70 indifferent rotational positions as the support tube 70 is rotated aboutits longitudinal axis. For example, each ratchet 104 is provided witheight ratchet teeth which allow the support tube to be rotated insixteen equal angular increments of 221/2 degrees. Each of the knobsections 101 and 102 has an enlarged rear section 107 provided withalternating longitudinal ridges 108 and finger-receiving grooves 109which facilitate the rotation of the adjusting knob 82 and the supporttube 70 by the surgeon.

The support tube 70 is an elongated, thin-walled rigid metal tube, e.g.,stainless steel. Inside the support tube 70 are mounted an elongatedstaple driver 76 and an elongated articulation driver 78 which areslidable longitudinally relative to the support tube 70 and relative toeach other. The articulation driver 78 pivots the stapling head assembly60 in response to movement of the saddle-shaped actuator 84 along theactuator handle assembly 80. The staple driver 76 actuates the stapleforming mechanism within the staple cartridge 62 when the stapleactuating lever 88 is operated. Preferably, the staple driver 76 and thearticulation driver 78 consist of stainless steel.

As shown in FIGS. 5 and 6, the staple driver 76 comprises an elongatedthin flat rod including a pair of spaced parallel flanges 110 whichextend longitudinally along its top and bottom edges. The staple driver76 has a pivot hole 111 (FIG. 6) adjacent to its distal end and alongitudinal slot 112 (FIG. 5) adjacent to its proximal end. Thearticulation driver 78 comprises an elongated thin flat rod which isslidably mounted adjacent to the staple driver 76 and is slidablyreceived between the flanges 110. The articulation driver 78 has anenlarged distal portion 113 (FIG. 6) with a laterally projecting guidepin 114 formed adjacent to its distal end. An assembly hole 115 (FIG. 5)is formed adjacent to the proximal end of the articulation driver 78. Adriver guide member 116 of generally cylindrical shape is mounted withinthe proximal end of the support tube 70. The driver guide member 116 hasa pair of opposed, outwardly extending posts 117 which are received in apair of corresponding holes 118 formed adjacent to the proximal end ofthe support tube 70. The driver guide 116 has a rectangular slot 119(FIG. 7) extending therethrough for slidably receiving the staple driver76 and the articulation driver 78.

As shown in FIGS. 2 and 5, a driver coupling member 120, preferably madeof plastic material, includes an opening 122 extending longitudinallytherethrough for receiving the proximal ends of the staple driver 76 andthe articulation driver 78. The driver coupling member 120 is secured tothe articulation driver 78 by a coupling pin 124 which is received inthe hole 115 in the articulation driver 78 and extends through a pair ofapertures 126 formed on opposite sides of the coupling member 120. Thecoupling pin 124 is slidably received in the longitudinal slot 112 ofthe staple driver 76 to allow the articulation driver 78 to slidelongitudinally relative to the the staple driver 76. A pair of spacedannular flanges 128 and 130 are provided at the proximal end of thecoupling member 120 for connection to an articulation control mechanismon the actuator handle assembly 80.

The saddle-shaped actuator 84 (FIG. 5) operates a slide member 132 whichis coupled to the driver coupling member 120 to operate the articulationdriver 78. The saddle slide member 132 is a generally flat metal platewith an elongated neck 134 projecting distally and having a pair ofcurved depending arms 136 provided with inwardly projecting fingers 138which are received between the annular flanges 128 and 130 on the drivercoupling member 120. The annular flanges 128 and 130 capture the fingers138 therebetween and connect the coupling member 120 to the saddle slidemember 132 for longitudinal movement therewith. The annular flanges 128and 130 allow the coupling member 120 to rotate about its longitudinalaxis relative to the saddle slide member 132 when the support shaft 70is rotated by the adjusting knob 82.

The saddle slide member 132 is slidably mounted on a pair of horizontalsupport ledges 140 (one shown) formed on the interior of the handlesections 91 and 92. Each support ledge 140 includes a series ofuniformly spaced notches 142 arranged in a longitudinal row. The saddleslide member 132 is formed with a transverse notch 144 for receiving aratchet pin 146 which is biased downwardly into the notch 144 by a coilspring 148 mounted on an inclined post 149 formed on the inside of thesaddle-shaped actuator 84. A pair of inclined fingers 150 (FIGS. 15 and16) is formed on the inside of the saddle-shaped actuator 84 and spacedfrom opposite sides of the post 149. The ratchet pin 146 extendstransversely between the fingers 150 and is slidably received in aninclined slot 151 formed in each of the fingers 150.

The opposite ends of the ratchet pin 146 are received in the notches 142formed in the support ledges 140. The notches 142 and ratchet pin 146provide a ratchet mechanism for controlling the angular orientation ofthe stapling head assembly 60 relative to the longitudinal axis of thesupport tube 70. The notches 142 provide a series of stop positionswhich correspond to angular orientations preferably of 0, 15, 30, 45 and60 degrees relative to the longitudinal axis of the support tube 70.

The saddle-shaped actuator 84 includes a pair of outwardly projectingribs 85 which serve as finger grips to facilitate the longitudinalmovement of the saddle-shaped actuator 84 along the handle assembly 60.The saddle-shaped actuator 84 includes a pair of inwardly projectingguides 87 (FIGS. 15 and 16) formed on each of its opposite sides whichare snap-fit and slidably received into a pair of longitudinallyextending channels 89 (one shown) formed on the exterior of the handlesections 91 and 92.

Referring to FIGS. 2 and 5, the staple actuating mechanism includes adriver link assembly 152 which is coupled to the staple driver 76 andactuated by the staple actuating lever 88. The driver link assembly 152comprises a block-shaped slide member 154, preferably of plasticmaterial, including a pair of vertically spaced flanges 156 extendingfrom its opposite sides. Each of the handle sections 91 and 92 includesa horizontal support ledge 158 which is received between one pair of theside flanges 156 to slidably support the driver link assembly 152 on theactuator handle assembly 80. A cylindrical connector pin 160 projectingdistally from the front of the slide block 154 includes an annular rim162 for connecting the drive link assembly 152 to the staple driver 76.The connector pin 160 is inserted into a buckle-like connector 164 atthe proximal end of the staple driver 76. The buckle-like connector 164has a pair of longitudinally spaced bands 166 and 168 which are curvedoutwardly in opposite directions and capture the annular flange 162therebetween to couple the staple driver 76 and the driver link assembly152 together for movement along the longitudinal axis of the supporttube 70. Also, the buckle-like connector 164 is free to rotate about theaxis of the connector pin 160 to allow the staple driver 76 and thearticulation driver 78 to rotate when the support tube 70 is rotatedabout its longitudinal axis.

As shown in FIGS. 2 and 5, the staple actuating lever 88 includes a pairof upright fingers 170 which are spaced apart to receive a rearwardlyprojecting lug 172 (FIG. 2) formed on the slide member 154. The lug 172is connected to a return coil spring 174 which is anchored to a post 176on the handle section 92. The return spring 174 normally urges the slide154 rearwardly into engagement with the upright arms 170 to retain thestaple actuating lever 88 in the unactuated position (FIG. 2).

The driver link assembly 152 includes a rearwardly projecting metal leafspring 178 which is curved downwardly at its proximal end and providedwith a pair of spring arms 180 projecting laterally from its oppositesides for engaging a pair of ratchets 182 (one shown) formed on thehandle sections 91 and 92. The spring arms 180 and the ratchets 182provide a ratchet mechanism which retains the driver link assembly 152at different stages of advancement as the staple actuating lever 88 isactuated. Once the spring arms 180 are engaged with the ratchets 182,the driver link assembly 152 cannot return to its unactuated positionuntil the stapling head assembly 60 is completely fired by operating thestaple actuating lever 88.

Referring to FIGS. 1 and 6, the stapling head assembly 60 is pivotallymounted at the distal end of the support tube 70 for pivotal movementabout an axis transverse to the longitudinal axis of the support tube70. The stapling head assembly 60 is pivotally mounted on the supporttube 70 by a pivot connection, generally 200, including a pair of pivothousings 201 and 202 of generally semi-cylindrical shape which are fittogether and are inserted into the distal end of the support tube 70.The pivot housings 201 and 202 are generally shaped as hollowsemi-cylindrical sleeves for slidably receiving the staple driver 76 andthe articulation driver 78. Adjacent to the proximal end of each of thepivot housings 201 and 202 is a semi-circular groove 204 which receivesan O-ring 206 for engaging the interior of the support tube 70. TheO-ring 206 helps to vent the staple cartridge 100 at the insufflationpressures of the abdominal cavity.

As shown in FIG. 6, each of the pivot housings 201 and 202 includes aside opening 208 formed therein adjacent to the groove 204. When thepivot housings 201 and 202 are assembled, silicone is injected into theside openings 208 about the staple driver 76 and the articulation driver78. With the pivot housings 201 and 202 inserted into the distal end ofthe support tube 70, a pair of dimples 210 (FIG. 7) is formed onopposite sides of the support tube 70 to deform the tube material intothe side openings 208 to fasten the pivot housings 201 and 202.Alternatively, in place of the injected silicone material, a hollowcylindrical silicone plug 209 (FIG. 6) can be inserted into the proximalends of the pivot housings 201 and 202. The silicone plug 209 includes apair of distally projecting flanges 211 which slidably engage the outersurfaces of the staple driver 76 and the articulation driver 78. Each ofthe pivot housings 201 and 202 includes a distally projecting tang 212which is provided with a pivot hole 214. The pivot housings 201 and 202include front semi-circular flanges 216 which engage the distal end ofthe support tube 70.

The pivot connection 200 includes a pair of clamshell members 221 and222 which are generally semi-cylindrical in shape and fit togetherinside a tubular clamshell sleeve 224. The clamshell members 221 and 222each include a front semi-circular flange 226 which engages the distaledge of the clamshell sleeve 224. The front flanges 226 each include aninterior semi-circular groove 228. Each of the pivot housings 221 and222 includes a detent arm 230 projecting inwardly through a side opening232. Also, each pivot housing 221 and 222 includes a rearwardlyextending tang 234 provided with an outwardly projecting pivot pin 236.The pivot pins 236 on the clamshell members 221 and 222 are pivotallyreceived in the pivot holes 214 on the pivot housings 201 and 202. Asshown in FIG. 4, the pivot housing 221 has an arc-shaped groove 238formed on its interior surface for receiving the guide pin 114 on thearticulation driver 78. The arc-shaped groove 238 and the guide pin 114convert longitudinal movement of the articulation driver 78 into pivotalmovement of the stapling head assembly 60. Preferably, the pivothousings 201 and 202 and the clamshell members 221 and 222 consist ofplastic material.

Referring to FIG. 6, the staple cartridge 100 of the stapling headassembly 60 has a hollow cylindrical housing 240 which is tapered at itsdistal end. Preferably, the staple cartridge housing 240 is a one-piecemolded plastic member. A hollow, generally cylindrical cartridgeretainer 242 is inserted into the open proximal end of the staplecartridge housing 240. The cartridge retainer 242 has a pair ofspring-like latch arms 244 located at diametrically opposed positions atthe front of the retainer 242. The latch arms 244 are snap-fitted into apair of diametrically opposed openings 245 adjacent to the proximal endof the cartridge housing 240 to hold the cartridge housing 240 and theretainer 242 together. The retainer 242 includes an annular flange 246which is received in the annular grooves 228 of the clamshell members221 and 222 to allow the staple cartridge 100 to rotate about itslongitudinal axis relative to the support tube 70 and to the pivotconnection 200. A set of twelve uniformly spaced circumferential teeth248 is formed at the proximal end of the retainer 242. The teeth 248 areengaged by the detent arms 230 on the clamshell members 221 and 222. Thedetent arms 230 and teeth 248 provide a ratchet mechanism which allowsthe rotational orientation of the staple cartridge 100 to be adjusted inincrements of 30 degrees.

Inside the staple cartridge 100 is mounted a staple forming mechanismcomprising an anvil 250, a staple holder 252 and a staple former 254which are preferably made of stainless steel. The staple former 254 ischannel-shaped in configuration for slidably receiving the staple holder252 therein. The staple former 254 has an elongated central slot 256with a depending prong 258 at the proximal end of the slot 256. Thestaple holder 252 includes a depending prong 260 which is slidablyreceived in the slot 256 and is biased away from the prong 258 by acompression coil spring 262. A feeder shoe 264 is slidably mountedwithin the staple cartridge 100 for urging a series of staples 65 towardthe distal end of the cartridge 100. The feeder shoe 264 is biased inthe distal direction by a compression coil spring 266 which is mountedon a distally projecting prong 268 on the cartridge retainer 242.

The staple driver 76 is connected to the staple former 254 by a plunger270 which is slidably mounted between the clamshell members 221 and 222.The plunger 270 is a generally flat metal plate, e.g. aluminum, andincludes a longitudinally extending side flange 272 slidably received ina longitudinal groove 274 formed in the clamshell member 222. Theplunger 270 has a pivot hole 276 adjacent to its proximal end. A pivotlink 278 includes a pair of laterally projecting pivot pins 280 and 282which are pivotally received in the pivot holes 111 and 276,respectively, to attach the staple driver 76 to the plunger 270. Thepivot link 278 transfers the longitudinal movement of the staple driver76 into longitudinal movement of the plunger 270. Also, the pivot link278 permits the plunger 270 to pivot relative to the staple driver 76.At the distal end of the plunger 270, a smaller diameter front disk 284is spaced from a larger diameter rear disk 286. The front disk 284 isinserted between a pair of inwardly projecting fingers 288 at theproximal end of the staple former 254 to transfer the longitudinalmovement of the plunger 270 into longitudinal movement of the stapleformer 254. The front disk 284 and the inwardly projecting fingers 288permit the staple former 254 to rotate relative to the plunger 270.

Referring to FIG. 9, the staple cartridge housing 240 has an elongatedhollow cylindrical wall 290 which preferably consists of transparentplastic material. Extending longitudinally inside the staple cartridgehousing 240 is a first pair of elongated upstanding flanges 292 whichare spaced apart and extend parallel to the longitudinal axis of thecylindrical wall 290. The elongated flanges 292 provide a set of guiderails for slidably supporting the staples 65 for longitudinal movementrelative to the staple cartridge housing 240. Each flange or guide rail292 has a ledge 293 (FIG. 10) which is inclined at an angle to the axisof the cartridge housing 240 and terminates in an extension 294 of theguide rail 292 at the open distal end of the cartridge housing 240. Eachof the flanges 292 is spaced inwardly from the cylindrical wall 290 toprovide a pair of elongated side channels 295 (FIG. 12) for receivingthe depending legs 68 of the staples 65. The cartridge housing 240includes a second pair of depending upper flanges 296 which are spacedapart and extend parallel to the longitudinal axis of the outercylindrical wall 290. The upper flanges 296 terminate above the lowerflanges 292 to provide a sufficient clearance therebetween to receivethe crowns 66 of the staples 65. On the inside of each lower flange 292is an elongated ledge 298 (FIG. 12) which slidably supports the stapleformer 254.

The staple cartridge housing 240 has a tapered nose 300 at its distalend including an internal horizontal ledge 302 provided with alongitudinal channel 304 for receiving the anvil 250 of the staplinghead assembly 100. The ledge 302 has a rearwardly projecting post 306 towhich the anvil 250 is secured. The tapered nose 300 has a centraldepending tab 308 located above the ledge 302 and provided with adownwardly sloped rear edge 309 which serves as a guide for the dimpledportion 67 of the staple 65 advanced by the staple forming mechanism.Also, the tapered nose 300 includes a pair of sloped ramps 310 (FIG. 11)on opposite sides of the central tab 308 for engaging the crown 66 ofthe staple 65 which is advanced by the staple forming mechanism to pivotthe staple 65 into an orientation parallel to the longitudinal axis ofthe cartridge housing 240. Each of the ramps 310 terminates at a ledge312 located adjacent to one of the extensions 294 of the guide rails292. A window 314 is formed on each side of the cartridge housing 240adjacent to one of the ramps 310 as a result of the molding process usedto form the cartridge housing 240.

As shown in FIG. 9, the staple former 254 is an elongated,channel-shaped member provided with upstanding side flanges 320extending along its opposite sides. The staple holder 252 is anelongated plate-like member which is slidably supported on the stapleformer 254 and located between the side flanges 320. The compressioncoil spring 262 normally biases the staple holder 252 distally relativeto the staple former 254 with the depending prong 260 biased against thedistal end of the elongated central slot 256. The staple holder 252 andthe staple former 254 are inserted into the staple cartridge 240 betweenthe lower upstanding flanges 292. The staple former 254 is slidablysupported on the ledges 298 formed on the inside of the flanges 292. Anejector arm 322 extending from the distal end of the staple holder 252has a notch 324 for receiving the dimpled portion 67 of the staple 65. Apusher finger 326 projects forwardly into the notch 324 at the distalend of the staple holder 252 for engaging the dimpled portion 67 of thestaple 65 as the staple holder 252 is advanced to move the staple 65into engagement with the anvil 250. The distal end of the ejector arm322 is slanted away from and above the level of the pusher finger 326and serves to disengage the staple 65 from the anvil 250 as the stapleholder 252 is retracted after the staple 65 is formed. A pair of fingers328 at the tip of the ejector arm 322 are spaced apart to receive thedepending tab 308 of the cartridge housing 240 therebetween.

The anvil 250 includes a pair of laterally spaced prongs (FIG. 9) 330 atits distal end which allow the ejector arm 322 to pass therebetween whenthe staple holder 252 is advanced. Each prong 330 includes an inclinedramp 332 (FIG. 1A) for guiding the crown 66 of the staple 65 intoengagement with the proximal side of the prong 330.

The staple follower 264 (FIG. 9) is channel-shaped and includes agenerally flat top portion 340 which is slidably received between thelower flanges 292 and the upper flanges 296. The staple follower 264also has a pair of depending side flanges 342 on its opposite sideswhich are received in the channels 295 adjacent to the lower flanges292. The staple follower 264 includes a rearwardly projecting post 344which is inserted into the distal end of the compression coil spring266.

Referring to FIGS. 9 and 19, a stack of staples 65 is mounted in thestaple cartridge housing 240 with the staple crowns 66 resting on andslidably supported by the elongated flanges or guide rails 292. Thedimpled portions 67 of the staples 65 rest on top of the staple holder252. The row of staples 65 is urged forwardly toward the distal end ofthe cartridge 240 by the staple follower 264 and the compression coilspring 266. The staple former 254 is biased rearwardly by the returnspring 174 (FIG. 2) in the actuator handle assembly 80 to urge thedepending prong 258 295 against the front of the retainer 242. Thestaple holder 252 is biased forwardly by the compression coil spring 262which urges the depending prong 260 against the front edge of the slot256 in the staple former 254. The ejector arm 322 at the distal end ofthe staple holder 252 is located adjacent to the guide tab 308 at thefront of the tapered nose 300 of the staple cartridge 240.

As shown in FIG. 19, the offset or dimpled portion 67 of the forwardmoststaple 65 is located at a level different from the remaining staples 65in the stack. The dimpled portion 67 of the forwardmost staple 65 isreceived in the notch 324 in front of the pusher finger 326. When thestaple holder 252 is advanced, the dimpled portion 67 of the forwardmoststaple 65 is advanced along the sloped surface 309 and adjacent to theguide tab 308 by the pusher finger 326. The top portion or crown 66 ofthe forwardmost staple 65 is advanced along a path between the inclinedramps 310 (FIG. 14) and the inclined ledges 293 of the guide rails 292to rotate the staple 65 by 90 degrees about its dimpled portion 67.

As shown in FIG. 20, with the staple holder partially advanced, theforwardmost staple 65 is rotated into a longitudinal orientation withits staple legs 68 parallel to the longitudinal axis of the staplecartridge housing 240. Thereafter, as shown in FIG. 21, when the stapleholder 252 is fully advanced, the forwardmost staple 65 travels alongthe extensions 294 of the guide rails 292 and is clamped against theanvil prongs 330 with the staple legs 68 projecting distally from thefront of the staple cartridge housing 240. The remaining staples 65 inthe stack are restrained by the top of the staple holder 252 whichengages the dimpled portions 67 of the staples 65.

The staple forming mechanism of the staple cartridge 100 is actuated bysqueezing the staple actuating lever 88 toward the handle grip 86. As aresult, the staple actuating lever 88 is pivoted about the pivot pin 96and the upright fingers 170 advance the slide member 154 in the distaldirection. The slide member 154 advances the staple driver 76 in thedistal direction which, in turn, advances the plunger 270 to actuate thestaple holder 252 and the staple former 254. After the staple holder 252and the staple former 254 are fully advanced to form one of the staples65, the staple actuating lever 88 is released and returned to itsoriginal position by the return coil spring 174, which retracts theslide block 154 and the staple driver 76.

The operation of the staple forming mechanism is illustrated in FIGS.22-26 which, for clarity, show only one staple 65. FIG. 22 shows thestaple 65 positioned in the notch 324 in front of the pusher finger 326at the start of the staple forming cycle which corresponds to theposition of the staple holder 252 and staple former 254 shown in FIG.19. Initially, when the staple actuating lever 88 is actuated, thestaple holder 252 and the staple former 254 are advanced simultaneouslyto advance the staple 65 toward the prongs 330 of the anvil 250. As thestaple 65 is advanced toward the anvil prongs 330, the staple 65 isrotated by 90 degrees into a longitudinal orientation (FIG. 20) with thestaple legs 68 pointing distally.

FIG. 23 shows the staple holder 252 and the staple former 254 advancedto a staple clamping position corresponding to FIG. 21 in which thestaple crown 66 is clamped between the pusher finger 326 and the prongs330 of the anvil 250. Thereafter, as the staple actuating lever 88 isactuated, only the staple former 254 is advanced while the staple holder252 remains stationary with the staple 65 clamped against the anvilprongs 330.

FIG. 24 shows the initial movement of the staple former 254 relative tothe staple holder 252 to form the staple 65 about the anvil prongs 330.The initial contact of the former flanges 320 with the staple 65 resultsin a slight bending of the staple crown 66 with the staple legs 68angled toward each other.

FIG. 25 shows an intermediate stage of the staple forming cycle in whichthe former flanges 320 are further advanced to bend the staple crown 66around the anvil prongs 330 to bring the staple legs 68 closer together.FIG. 26 shows the final stage of the staple forming cycle in which theformer flanges 320 are fully advanced to bend the staple legs 68 into anoverlapping configuration to secure the staple 65 to the tissue.

After the staple 65 is completely formed, the staple actuating lever 88is released and the staple former 254 is moved rearwardly relative tothe staple holder 252 by the compression coil spring 262. When thedepending lug 260 of the staple holder is engaged (as shown in FIG. 21)by the front edge of the slot 256 of the staple former 254 (FIG. 9), thestaple holder 252 and the staple former 254 are retracted together bythe return spring 174 in the actuator handle assembly 80. The ejectorarm 322 lifts the formed staple 65 from the anvil prongs 330 as thestaple holder 252 is retracted. The staple holder 252 and the stapleformer 254 are returned to the start position shown in FIG. 19 where thenext staple 65 is received in the notch 324 in front of the pusherfinger 326. Then, the staple forming cycle is repeated to form the nextstaple 65.

The actuator handle assembly 80 includes a precock racthet mechanismcomprising the ratchet spring (FIGS. 5 and 27-31) and the ratchets 182which prevents the retraction of the staple forming mechanism until thestaple 65 is completely formed. The operation of the ratchet mechanismis illustrated in FIGS. 27-31 which show the various ratchet positionscorresponding to the stages of the staple forming cycle shown in FIGS.22-26, respectively.

As shown in FIG. 27, each spring arm 180 of the ratchet spring 178 isinitially disengaged from each ratchet 182 with the staple holder 252and the staple former 254 located in the retracted position (FIG. 22).As shown in FIG. 28, each spring arm 180 of the ratchet spring 178 isengaged in the first notch of each ratchet 182 with the staple holder252 and the staple former 254 in the advanced position (FIG. 23) inwhich the staple 65 is clamped against the anvil prongs 330. Thereafter,the engagement of the ratchet spring arms 180 with the ratchets 182prevents the staple holder 252 and the staple former 254 from beingretracted until the staple forming cycle is completed.

As shown in FIG. 29, each spring arm 180 of the ratchet spring 178 isengaged in the second notch of each ratchet 182 with the flanges 320 ofthe staple former 254 initially engaged with the staple crown 66 tobegin the forming of the staple 65 (FIG. 24). As shown in FIG. 30, eachspring arm 180 of the ratchet spring 178 is engaged in the third notchof each ratchet 182 with the former flanges 320 advanced to theintermediate stage of the staple forming cycle (FIG. 25) in which thestaple legs 68 are partially closed.

As shown in FIG. 31, each spring arm 180 of the ratchet spring 178 isdisengaged from each ratchet 182 with the former flanges 320 fullyadvanced (FIG. 26) to bend the staple legs 68 into an overlappingrelationship. Each spring arm 180 travels rearwardly adjacent to theunnotched side of the corresponding ratchet 182 to allow the ratchetspring 178 to return to its retracted position (FIG. 27) when the stapleactuating lever 88 is released.

In performing a hernia repair procedure, the endoscopic surgicalstapling instrument 50 is inserted into a body cavity through a trocartube or cannula installed in a body wall. Initially, the surgicalstapling instrument 50 is introduced into the body cavity in itsnon-articulated mode, i.e., with the staple cartridge 100 aligned withthe longitudinal axis of the support tube 70. An endoscope may beinserted into the body cavity through a separate trocar tube or cannulafor observation of the surgical site. The stapling cartridge 100 ispositioned in the desired orientation over the surgical site byoperating the rotatable adjusting knob 82 and the saddle-shaped actuator84 to adjust the rotational orientation of the support tube 70 and theangular orientation of the staple cartridge 100. The staple cartridge100 can be articulated to angles of 15, 30, 45 and 60 degrees relativeto the support tube 70 by retracting the saddle-shaped actuator 84.

If it is desired to change the rotational orientation of the staplecartridge 100 on its axis, the staple cartridge 100 is returned to thenon-articulated mode by sliding the saddle-shaped actuator 84 forwardly.The surgical stapling instrument 50 is withdrawn from the trocar tube orcannula and the staple cartridge 100 is rotated manually relative to thesupport tube 70. Then, the surgical stapling instrument 50 isreintroduced into the body cavity in its non-articulated mode and theorientation of the staple cartridge 100 is adjusted by operating therotatable adjusting knob 82 and the saddle-shaped actuator 84.

With the staple cartridge 100 adjusted to the desired orientation, thestaple actuator lever 88 is squeezed to actuate the staple formingmechanism in the staple cartridge 100 to fasten one of the staples 65 tothe tissue at the surgical site. Thereafter, the staple cartridge 100 isshifted to another location and the operation is repeated to fastenanother staple 65 to the tissue. When the staple actuator lever 88 isreleased, the formed staple 65 is disengaged from the anvil 250 of thestaple cartridge 100.

Referring to FIG. 18, the surgical stapling instrument 50 can be used tosecure a hernia patch 62 at a desired surgical site. The hernia patch 62is attached to internal body tissue 64 by applying a series of staples65 to the edges of the hernia patch 62. The staple cartridge 100 isreadily adjustable into the different orientations to apply the staples65 at various locations along the edges of the hernia patch 62.

FIGS. 32 and 33 illustrate an alternative embodiment of the surgicalstapling instrument, generally 350, including a distal stapling headassembly 360 which is pivotally connected to an elongated support tube370 rotatably mounted on a proximal actuator handle assembly 380. Arotatable adjusting knob 382 is mounted at the distal end of theactuator handle assembly 380 for rotating the support tube 370 about itslongitudinal axis. A saddle-shaped actuator 384 is slidably mounted onthe actuator handle assembly 380 for controlling the pivotal movement ofthe stapling head assembly 360 relative to the support tube 370. Theactuator handle assembly 380 has a depending handle grip 386 and apivotally mounted staple actuating lever 388 for actuating the staplinghead assembly 360. The internal components of the stapling head assembly360, the support shaft 370 and the actuator handle assembly 380 aresubstantially identical to the corresponding components of the surgicalstapling instrument 50 described above. Accordingly, no detaileddescription of the internal components of the surgical staplinginstrument 350 is necessary, and it will be understood by personsskilled in the art that the previous description of the internalcomponents of the surgical stapling instrument 50 is applicable to theinternal components of the surgical stapling instrument 350, unlessotherwise described.

The stapling head assembly 360 includes a rotatably mounted staplecartridge 400 which is substantially identical in construction to thestapling cartridge 100 described above. The stapling head assembly 360is pivotally mounted on on the support tube 370 by a pivot connection390 which is substantially identical to the pivot connection 200described above.

As shown in FIG. 33, the handle assembly 380 includes a pair of hollowhandle sections 392 which are adapted to snap fit together. Each of thehandle sections 392 includes a distally extending elongated,semi-cylindrical neck portion 394 in which the proximal end of thesupport tube 370 is received and mounted for rotation about itslongitudinal axis relative to the handle assembly 380. Each of thehandle sections 392 includes an internal annular flange 395 (one shown)for engaging a radially projecting flange 372 at the proximal end of thesupport tube 370 to retain the support tube 370 within the handleassembly 380. The staple actuating lever 388 is pivotally mounted on theactuator handle assembly 380 by a pivot pin 396.

As shown in FIGS. 32 and 33, the adjusting knob 382 comprises a pair ofelongated, hollow tapered sleeve-like sections 402 which fit togetherover the neck portions 394 of the handle sections 392. Each of thesleeve-like knob sections 402 has an inwardly projecting prong 403adjacent to its distal end. The prongs 403 are received in a pair ofholes formed on opposite sides of the support tube 370 to secure theknob sections 402 to the support tube 370. The actuator handle assembly380 and the adjusting knob 382 include the same ratchet mechanism,described above in connection with the stapling instrument 50, whichallows the adjusting knob 382 to rotate the support shaft 370 about itslongitudinal axis in sixteen equal intervals of 221/2 degrees. Each ofthe knob sections 402 has an enlarged rear section 407 provided withalternating longitudinal ridges 408 and finger receiving grooves 409which facilitate the rotation of the adjusting knob 382 and the supporttube 370 by the surgeon.

The actuator handle assembly 380 includes a rotatable control knob 410for controlling the rotation of the staple cartridge 400 about itslongitudinal axis relative to the support shaft 370. The control knob410 includes an elongated hollow, conically tapered portion 412 which isrotatably received between the sleeve-like sections 402 of the adjustingknob 382 and the cylindrical neck portions 394 of the handle sections392. A hollow cylindrical, internally toothed geneva gear wheel 414 issecured within the distal end of the conically tapered body 412 forrotation with the control knob 410. A first pinion gear 416 which isrotatably mounted on the inside of the support tube 370 extends througha window 372 (FIG. 35) formed in the side of the support tube 370 andengages the internal teeth on the geneva gear wheel 414. The pinion gear416 is attached to a flexible cable 418 which extends longitudinallythrough the support shaft 370 and the pivot connection 390. The distalend of the flexible cable 418 is connected to a second pinion gear 420rotatably supported in a bushing 422 (FIG. 34) mounted on the inside ofone of the clamshell members 424 forming part of the pivot connection390. The flexible cable 418 is formed of conventional materials such assteel alloys. The staple cartridge 400 is mounted on a cylindricalretainer 426 which is rotatably supported by the clamshell members 424of the pivot connection 390. The cartridge retainer 422 has aninternally toothed geneva gear wheel 428 (FIG. 36) at its proximal endwhich engages the pinion gear 420.

In the operation of the surgical stapling instrument 350, the controlknob 410 is used to control the rotational orientation of the staplecartridge 400 relative to the support shaft 370 and the pivot connection390. The rotation of the control knob 410 is transmitted via theflexible cable 418 to the cartridge retainer 422 which rotates thestaple cartridge 400 about its axis. As a result, the rotationalorientation of the staple cartridge 400 relative to the support shaft370 is adjustable by the rotation of the control knob 410.

Except for the control knob 410 which rotates the staple cartridge 400,the surgical stapling instrument 350 operates in substantially the samemanner as the stapling instrument 50 described above. The rotatableadjusting knob 382 is used to rotate the support shaft 370 relative tothe actuator handle assembly 380. The saddle-shaped actuator 384 isslidable longitudinally along the actuator handle assembly 380 to pivotthe stapling head assembly 360 about an axis transverse to thelongitudinal axis of the support shaft 370. The staple actuating lever388 is pivoted to actuate the staple forming mechanism of the staplecartridge 400 in substantially the same manner as described above.

FIGS. 37-40 show an alternative embodiment of a stapling head assembly,generally 460, which can be used with the surgical stapling instrument50 described above. The stapling head assembly 460 is pivotally mountedat the distal end of the support tube 70 by a pivot connection 470including a tubular pivot housing 472 secured to the support tube 70 anda tubular cartridge support member 474 pivotally connected to the pivothousing 472 by a pair of pivot pins 476 extending laterally fromopposite sides of the cartridge support member 474. An inclined slot 478is formed on one side of the cartridge support member 474.

A staple cartridge 500 is mounted at the distal end of the cartridgesupport member 474. The staple cartridge 500 is generally cylindrical inshape and is adapted to be received in the open distal end of thecartridge support member 474. The staple cartridge 500 has a pair oflatch pins 502 projecting radially outward its opposite sides. The latchpins 502 are received and latched in a pair of slots 504 extendinglongitudinally from the distal end of the cartridge support member 474.The latch pins 502 and slots 504 allow the staple cartridge 500 to bedisengaged from the cartridge support member 474 when it is desired toreplace the staple cartridge 500.

As shown FIG. 40, an articulation control member 480 is slidably mountedin the pivot housing 472 and is connected to the articulation driver 78.A laterally projecting guide pin 482 is located adjacent to the distalend of the articulation control member 480 and is slidably received inthe inclined slot 478 of the cartridge support member 474. The inclinedslot 478 and the guide pin 482 convert longitudinal movement of thearticulation driver 78 into pivotal movement of the stapling headassembly 460 about the pivot pins 476.

As shown in FIG. 39, a plunger 490 is slidably mounted for longitudinalmovement in the cartridge support member 474. The plunger 490 includesan elongated laterally projecting side flange 492 which is slidablyreceived in a longitudinal slot 494 (FIG. 38) formed on the side of thecartridge support member 474. The plunger 490 has a semi-circular rearedge 495 which is engaged by an inclined cam surface 496 on a drivemember 498 mounted at the distal end of the staple driver 76. The frontend of the plunger 490 is engaged with the staple forming mechanisminside the staple cartridge 500.

When the staple driver 76 is advanced in the distal direction, theplunger 490 is advanced to actuate the staple forming mechanism of thestaple cartridge 500 which operates in substantially the same manner asdescribed above. The semi-circular rear edge 496 of the plunger 90 andthe inclined cam surface 498 at the distal end of the staple driver 76allow the staple forming mechanism to be actuated in any angularorientation of the staple cartridge 500.

The invention in its broader aspects is not limited to the specificdetails of the preferred embodiments shown and described, and thoseskilled in the art will recognize that the invention can be practicedwith modification within the spirit and scope of the appended claims.

We claim:
 1. A surgical stapling instrument for applying one or moresurgical staples to tissue, comprising:a handle including a stapleactuator mechanism; a tubular support shaft having a longitudinal axisand extending from said handle; a staple cartridge mounted on saidsupport shaft and connected to said staple actuator mechanism forapplying one or more staples seriatim to the tissue; and said staplecartridge being mounted for pivotal movement relative to said supportshaft about an axis transverse to said longitudinal axis of said supportshaft; and wherein said cartridge comprises:a cartridge housing adaptedto receive a plurality of staples in a row for longitudinal movementtherethrough; an anvil mounted on said housing; means for advancing theforwardmost staple in the row into engagement with said anvil; means forrotating the forwardmost staple from a transverse orientation into alongitudinal orientation as the staple is advanced toward said anvil;and means for forming the forwardmost staple about said anvil to attachthe staple to the tissue.
 2. The staple cartridge of claim 1, whereinsaid staple advancing means comprises;a staple holder slidably mountedwithin said cartridge housing for advancing the forwardmost staple fromthe row and clamping the staple against said anvil.
 3. The staplecartridge of claim 1, wherein said staple rotating means comprises:rampmeans on said cartridge housing for engaging and rotating theforwardmost staple into a longitudinal orientation as the staple isadvanced by a staple holder.
 4. The staple cartridge of claim 3, whereinsaid staple forming means comprises:a staple former slidably mountedwithin said cartridge housing for movement relative to said stapleholder and adapted to form the forwardmost staple about said anvil.